​Coverage for preventive PrEP services

September 20, 2021

Effective September 18, 2021, AmeriHealth will cover the following services related to the administration of pre-exposure prophylaxis (PrEP) for individuals who are considered high risk for HIV infection. The coverage is in accordance with a jointly issued preventive coverage clarification issued by the Departments of Labor, Health and Human Services (HHS), and the Treasury. 
The services are:

  • HIV testing 
  • Hepatitis B and C testing
  • Creatinine testing and calculated estimated creatine clearance (eCrCl) or glomerular filtration rate 
  • Pregnancy testing 
  • Sexually transmitted infection (STI) screening and counseling 
  • Adherence counseling

Please read the Medical Policy News Article for background, eligible procedure codes, and links to impacted policies.